Early detection of liver cancer: Diagnosis and management

Abstract

Hepatocellular carcinoma (HCC) is the fifth most common cause of cancer deaths worldwide, and the incidence is rising. Despite a wide array of treatment options, fewer than half of candidates for potentially curative treatments receive them. The diagnosis and management of HCC require a multidisciplinary approach involving various clinical specialties. The foundation of diagnosis is high-quality imaging, with MRI being the test of choice. Some patients also require guided biopsy when MRI is equivocal. Treatment options depend upon the tumor stage and the degree of underlying synthetic dysfunction. Potentially curative treatments include surgical resection and transplantation. Other treatments that prolong survival include percutaneous ablation and transarterial chemoembolization. A new oral agent, sorafenib, was recently shown to prolong survival in patients with advanced HCC. By increasing surveillance and treatment of HCC, outcomes for these patients may be improved.

Hepatobiliary Cancers

“…An estimated 60% to 80% of persons with HCC have underlying cirrhosis, 8 possibly approaching 90% in the United States. 10 Although most studies evaluating the risk for development of HCC in individuals infected with HCV have focused on populations with cirrhosis, limited data show that HCC can occur in some patients infected with HCV with bridging fibrosis in the absence of overt cirrhosis. 11 Importantly, certain populations chronically infected with HBV (i.e., hepatitis B carriers) have been identified as being at increased risk for HCC in the absence of cirrhosis, especially when other risk factors are present (e.g., family history of HCC); 4 an estimated 30% to 50% of patients with chronic HBV infection who develop HCC do not have underlying cirrhosis.…”

“…4,32,33 The term triphasic refers to the 3 phases of scanning: an arterial phase, portal venous phase, and the venous phase after a delay. 10 The classic imaging profile associated with an HCC lesion is characterized by intense arterial uptake or enhancement followed by contrast washout or hypointensity in the delayed venous phase. 4,33,34 …”

“…Nevertheless, use of needle biopsy to diagnose HCC is limited by several factors, including sampling error, particularly when lesions are between 1 and 2 cm. 4,10 Patients for whom a non-diagnostic biopsy result is obtained should be followed up closely, and subsequent additional imaging and/or biopsy is recommended if a change in nodule size is observed.…”

“…4,10 However, results of AFP testing can be useful in conjunction with other test results to guide management of patients believed to have HCC. For example, additional imaging studies (i.e., CT/MRI) are recommended for patients with a rising serum AFP level in the absence of a liver mass (see page 352).…”

“…10,38,39 These biomarkers include des-gamma-carboxy prothrombin (DCP), also known as protein induced by vitamin K absence-II (PIVKA-II), and lens culinaris agglutinin-reactive AFP (AFP-L3), an isoform of AFP.…”